DOI: 10.3791/66251-v
This article provides a whole technical process of laparoscopic duodenum-preserving pancreatic head resection via an inferior infracolic approach. This is a surgical approach for benign tumors without intraoperative fluorescence image guidance.
To begin, perform an abdominal laparoscopic examination and suspend the transverse colon's enteric fat over the liver's falciform ligament to expose the infrasonic compartment. With an ultrasonic scalpel, make an incision in the front of the duodenum transverse mesocolon to expose the pancreatic head. Next, expose the infracolic compartment between the transverse colon and the pancreatic head, and fully free the superior mesenteric vein from the uncinate process of the pancreas.
Use clips to transect its tributary. Now use the ultrasonic scalpel to dissect the inferior margin of the uncinate process of the pancreas. Pull up the margin of the uncinate process of the pancreas to expose the sub pancreaticoduodenal vessels branch into the uncinate process.
Then clip to transect them. Replace the transverse colon position and section the gastric ligament to expose the pancreas behind the stomach. Then suspend the stomach body over the liver falciform ligament to set it free from the pancreas with a red urine catheter and a clip.
Next, expose the common hepatic artery and gastroduodenal artery. Ligate and detach the branches of anterior superior pancreaticoduodenal artery into the uncinate process of the pancreas with a clip. Then remove the pancreas from the medial side of the duodenal ring and anterior superior pancreaticoduodenal artery.
Cut off the peritoneum at the lower margin of the pancreatic head. Ligate and detach the right gastroepiploic vein. Then flip the uncinate process of the pancreas to the head side to expose the superior mesenteric vein.
With a pair of Harmonic scissors, transect the pancreatic neck in front of the superior mesenteric vein. Detach the pancreatic head from the right and dorsal edges of the superior mesenteric vein. Then detach the upper part to expose the distal common bile duct.
Perform dissection along the left and dorsal margins of the common bile duct to expose and safeguard the posterior superior pancreaticoduodenal artery. Sever the anterior superior pancreaticoduodenal artery to facilitate deeper dissection. Insert an external ventricular drainage catheter after identifying the main pancreatic duct.
Perform an end-to-side pancreaticojejunostomy, and side-to-side jejunostomy. Place the specimen inside a bag and remove it through a five-centimeter incision on the lower abdomen. Finally, place two drainage catheters near the pancreaticojejunostomy, and the common bile duct, and bring them out through two trocar port sites.
Postoperative pathology revealed a 2.5 by 1.5 centimeter intraductal papillary mucinous neoplasm.
